The Impact Of Ethnicity On Antidepressant Therapy 2025

Week #3 – Main Post Three Questions I might ask the client I would ask the client if he is currently depressed. This question will allow me to determine if there was a certain trigger for this depressive episode. The question will allow the client to share his thoughts about how he is viewing is current mental state. Are you often irritable with others, including coworkers due to the stress and demands of your career? How would you describe your mood at work? This question will help establish how he interacts with his coworkers. Have you in the past 3-4 weeks had any thoughts of suicide or causing harm to others around you? Clients that have major depressive disorder may have suicidal thoughts. The age of the client and having depressive episodes after each divorce also place the client at a higher risk (Taylor, 2015). The need for a suicide risk assessment is present. Identify people in the client’s life I need to speak to The client has provided a family history that includes multiple relatives being diagnosed with depression. I would of course first ask permission of the client to interview the family members and coworkers without violating the client’s confidentiality. The family member with the history of depression would be good people to speak with about depression. The family members may be able to offer some insight to the symptoms the client is currently having. The nurse practitioner would then have the opportunity to ask the family how they deal with their depression. Do they take antidepressant medication? Have they tried psychotherapy? If so have they seen any positive effects from the chosen therapy? The coworkers would also be good people to ask about the client. The coworkers could be asked if they have noticed any changes in the client’s behavior or moods while at work. Diagnostic Tests and Physical Exams The client has not been taking any tricyclic antidepressants (TCAs) recently so blood level monitoring is not indicated (Blackburn, Ho, & Wiese, 2017). A physical assessment can be done on the client but the past medical history does not provide a reason for diagnostic testing. As a routine check, a urine drug test and urine analysis can be performed. However, the thyroid gland has been linked to some mood disorders. Thyroid hormones can have an influence on the brain impacting the mood and cognition (Pilhatsch, Marxen, Winter, Smolka, & Bauer, 2011). The thyroid stimulating hormone (TSH) levels can be checked to see if they are within normal range. If indicated, thyroid hormone treatment can enhance antidepressant therapy and provide maintenance therapy for some bipolar disorders (Pilhatsch, Marxen, Winter, Smolka, & Bauer, 2011). Differential Diagnosis Bipolar II Mixed – The client has depressive and manic symptoms currently. The depressive symptoms include depression episodes after each divorce, actively suicidal at one point, and overdosed on medications previously. According to Stahl (2013) manic episodes include irritable mood, decreased need for sleep, over talkativeness, euphoria, and hypomanic phases. I feel that the client mostly identifies with this diagnosis. Major Depressive Disorder – Depression is one of the most common mental health disorders. The client has different episodes of major depression reoccurring three times with each divorce. The client was diagnose at age 23 for the first time with depression and has had many episodes lasting a week or more. Borderline Personality Disorder – The client’s chief complaint was “unstable”. The client provided examples of emotional instability with the depressive episodes after each divorce. The client suffered “emotional trauma” as a child as a result of his mother and the emotional instability in his unsuccessful relationships. The client has difficulty returning to a stable baseline after emotionally triggered events (Stahl, 2013). Two Pharmacologic Agents Olanzapine – is an atypical that can improve the mood while treating resistant depression (Stahl, 2013). This medication can work better when combined with fluoxetine. The client also expressed concern about weight gain and this medication causes a chance of weight gain. This medication is usually a second line of treatment option but the client has tried other medications unsuccessfully. The dosing is approved for 10-15mg/day, but the higher the dosage the greater the improvement in the symptoms. Fluoxetine – The client has already tried this medication and it does provide relief from the depression symptoms, usually seen after the first dose. However the client has not taken this medication along with olanzapine. Fluoxetine in combination with olanzapine can treat bipolar depression more effectively. Both medications have the 5HT2C antagonist actions. The two mechanisms can boost the dopamine receptors and the norepinephrine release in the prefrontal cortex causing the improvement in the clinical symptoms (Stahl, 2013). Follow up Check Points Once the client returned for the first follow up and expressed the concerns about the sexual dysfunction and decreased libido, I would have wanted to prescribe him an alternate therapy. The client has already expressed having depressed episodes after each divorce. I would not want him to stay on a medication that can cause him to have a poor image of himself if he cannot perform sexually. This client would probably benefit from combination therapy which means psychotherapy would need to be added into his treatment plan. He did say he would be okay with it as long as he had a therapist he respected. The next follow up appointment at week 16, the client has stopped the lamotrigine due to the sexual side effects. I would have already prescribed the patient an antipsychotic medication and increased his follow up appointment frequency. The client’s history of the many depressive episodes indicate the need for close monitoring. Lesson Learned The main lesson here is that the physician should not be treating and prescribing himself medications. The client is having a hard time trusting that other physicians and providers can offer him the help and treatment he needs. As the advanced practice nurse, I would find ways to incorporate him into his treatment plan while educating him on the benefits of certain medication therapy. Hopefully the client will take medication long enough to see the benefits of the treatment. Mental health can be challenging and this client case study is no different than real life practice. As the provider, I would just have to continuously think of ways to treat the patient safely. References Blackburn, P., Wilkins-Ho, M., & Wiese, B. (2017). Depression in older adults: Diagnosis and management. BC Medical Journal , 59(3), 171-177. Retrieved from https://www.bcmj.org/articles/depression-older-adults-diagnosis-and-management Pilhatsch, M., Marxen, M., Winter, C., Smolka, M., & Bauer, M. (2011). Hypothyroidism and mood disorders: Integrating novel insights from brain imaging techiniques. Thyroid Research , 4(S3). Retrieved from https://thyroidresearchjournal.biomedcentral.com/articles/10.1186/1756-6614-4-S1-S3 Stahl, S. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applicatons (4th ed.). New York, NY: Cambridge University Press. Taylor, W. (2015). Should antidepressant medications be used in the elderly? Expert Review of Neurotherapeutics , 15(9), 91-93. doi: 10.1586/14737175.2015.107.0671 I need a response for this assignment, 1 page zero plagiarism 2 references

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The Impact Of Ethnicity On Antidepressant Therapy 2025

The Case # 1: The man whose antidepressants stopped working The 63 yr-old with the worst depression and anxiety he has ever felt. He is married for 33 years and with 3 children. He is a non-smoker and non-drug and alcohol abuse. He has a medical history of Atrial fibrillation and Hypercholesterolemia. He has a family history with depression that is the mother, son, and daughter. Three Questions I might ask the patient if he were in my office. What is your current problem, symptoms, and thoughts? What are your interpersonal or psychosocial stressors? Rationale: The goal is to learn more about the patient, his current problems and symptoms; a complete history of previous symptoms; a family history; a history of significant stressful life events (psychosocial stressors); information concerning lifestyle, culture, social support structure and any suicidal thoughts or tendencies the person may be experiencing. Are you comfortable if we can involve your family members or significant other in psychoeducation and treatment? Rationale: According to Gulf Bend Center (n.d.a.) one of the well-studied sociological factors that helps prevent depression is known as “social support.” Social support simply refers to whether or not people have access to and make use of a network of interpersonal relationships for supportive purposes. People receive social support from their family, friends, work, and significant others. Social support networks provide a shoulder, guidance, love, caring, entertainment, laughs, and other types of mental and physical assistance during times of need and crisis. For your recurrence depression, can we try a combination of medication and psychotherapy? Rationale: Psychotherapy has been recommended for the treatment of depression which includes cognitive-behavioral therapy (CBT), interpersonal psychotherapy, and problem-solving therapy. CBT is considered as the first-line and most evidence-based psychological therapy for depression. CBT works by identifying any dysfunctional thoughts and replacing them with more helpful ones, with the intent of modifying negative behaviors and emotions that perpetuate the depression (Ng, How & Ng, 2017). Physical Exams and diagnostic tests appropriate for the patient and how the result would be used. Although his vital signs are normal where we have BP normal, BMI normal and normal fasting glucose and triglycerides it is very important to do lab measurements and to screen for thyroid dysfunction and dexamethasone suppression test. According to Samuels (2018), it should be a routine clinical practice to screen patients with depression for thyroid dysfunction. Many patients with depression who are screened for thyroid dysfunction have mildly elevated thyrotropin (TSH) and normal free thyroxine (T4) levels (mild or subclinical hypothyroidism). The patient and care provider may attribute the depressive symptoms to mild thyroid disorder and initiate L-T4 therapy. Also, a complete diagnostic evaluation for depression should include tests for bacterial and viral infections, metabolic deficiencies, and autoimmune conditions. Depressive symptoms are sometimes measured with general questionnaires designed to look at several different types of mental conditions as once. The general health questionnaire (GHQ) is a screening test for identifying minor psychiatric disorders in the general population. It looks at the person’s current state and asks if that is different from the usual state. It is sensitive to short-term psychiatric disorders, but not to long-standing characteristics of the person. This self-administered questionnaire focuses on two major areas: the inability to function in daily life and the appearance of new and distressing symptoms (Gulf Bend Center, n.d.a.) Three differential diagnoses for the patient: Identify one that is most likely diagnoses. According to the criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (n.d.a.) and using the screening tools, the diagnosis established would be Major Depressive Disorder (MDD) where the clinician needs to differentiate and identify other conditions that may have similar symptoms. This will help to provide information about a person’s anticipated course of the disorder and their prognosis (outcome). The clinician may use the following differential diagnosis to describe the current or most recent Major Depressive Disorder: Mood disorder due to another medical condition. Adjustment disorder with depressed mood. Melancholic Features The most likely diagnosis of the 63 yrs-old is MDD with melancholic features that have been described by the most severe stages of his five (5) episodes which include: An inability to enjoy anything and does not react to anything pleasurable along with a mood that is regularly worse in the morning. Early morning awakening (at least two hours before the usual time) Thinking of moving slowly. Significant loss of appetite or unplanned weight loss. Excessive or inappropriate guilt. Two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy. According to Stahl’s (2013) adults between the ages of 25 and 64 might have the best chance of getting a good response and with the best tolerability to an antidepressant. In his fourth episode, he was prescribed venlafaxine XR (Effexor XR) which worked even faster as compared with the other antidepressants and the patient did not have sexual dysfunction but discontinued after less than a year. This was a major mistake to discontinue the medication because he already had a family history and recurrent episodes of depression. Venlafaxine XR is a Norepinephrine and dopamine reuptake inhibitors (NDRIs) work in the same way as the other neurotransmitter reuptake inhibitors. NDRIs Venlafaxine frequently seems to have greater antidepressant efficacy as the dose increases theoretically due to recruiting more and more Norepinephrine transporter (NET) inhibition as the dose is raised. After the fifth episode after taking Venlafaxine XR for 15 months there was no relief of the symptoms which can be a result of the patient had become resistant and as his age progresses to 63 yrs-old also the changes in brain structure and neurotrophic factors. Due to recurrent, and recurrences of depression which possibly indicate disease progression potentially manifested as shorter and shorter periods of wellness between subsequent episodes, which has resulted to poor inter episode recovery and ultimately, treatment resistance thus the need to introduce tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) which are regarded as second-line and third-line due to their tolerability and safety profile. Tricyclic antidepressants have antagonist action at 5HT2A and 5HT2C which could contribute to their therapeutic profile. Monoamine oxidase inhibitors (MAOIs) are enzymes that break down serotonin, norepinephrine, and dopamine. By preventing these enzymes from working MAOI medications allow neurotransmitters to remain the synaptic gap longer thus giving more opportunity to activate the post-synaptic neuron’s receptor and create greater stimulation of the post-synaptic recipient neuron. Increasing serotonin, norepinephrine and dopamine levels tend to have an antidepressant effect. There is no contraindication to use as a treatment for depression due to the patient ethnicity although TCAs can cause anticholinergic effects (dry eyes, constipation, and urinary hesitancy) and be lethal if overdosed. MAOIs can lead to a hypertensive crisis if combined with tyramine-rich foods such as cheese and many medications, including common primary care drugs such as decongestants and cough syrups (Stahl’s, 2013). As a clinician, when prescribing treatment for depression patients may have to try several different medications before finding one that works well. Even within a group of similar antidepressant medications, some people do better with one than with others. The decision about when it is time to try new medications is best made when the patient, clinician and psychotherapist work together as a team. For this patient, I believe the combination of psychotherapy and medication would have been beneficial and probably he would have been able to get to a point where he could gradually decrease or discontinue the use of antidepressants. He would have learned how to maintain well-being by using skills learned in psychotherapy. However, for those individuals whose depression returns when they stop using the medication, long-term use of antidepressants may be necessary. Reference Diagnostic and Statistical Manual of Mental Disorders (DSM-5)(n.d.a.). Retrieved on March 11th, 2020 from https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t5/ Gulf Bend Center (n.d.a.). Depression: Depression & related conditions basic information. Retrieved on March 11th, 2020 from https://www.gulfbend.org/poc/center_index.php?cn=5 Ng, C. W. M., How, C. H., & Ng, Y. P. (2017). Managing depression in primary care. Singapore Med J. 58(8), 459-466,doi.org/10.11622%2Fsmedj.2017080 Samuels, M. H. (2018). Subclinical hypothyroidism and depression: Is there a link? The Journal of Clinical Endocrinology & Metabolism . 103(5), 2061-2064, doi.org/10.1210/jc.2018-00276 Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical application, (4th ed.). Cambridge University Press. I need a response from this assignment. 1 page zero plagiarism 2 references

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